The proportion of women …

 

  • who are HIV-infected
  • who become pregnant
  • who do not seek prenatal care
  • who are not offered HIV testing
  • who refuse HIV testing
  • who are not offered the ACTG 076 regimen
  • who refuse the ACTG 076 regimen
  • who do not complete the ACTG 076 regimen
  • whose child is infected despite treatment

FIGURE 1.1

Chain of events leading to an HIV-infected child.

communities. Chapter 3 provides relevant information on the descriptive epidemiology of HIV and AIDS in women and newborns. Chapter 4 summarizes the scientific and clinical information about the detection and treatment of HIV infection in pregnant women and newborns, and includes a summary of current official clinical screening and treatment guidelines. The committee accepted these as they stand, and did not attempt to make clinical recommendations. Chapter 5 described the current context of services for women and children affected by HIV and AIDS.

The committee's conclusions and recommendations are concentrated in the final two chapters. Chapter 6 reviews the implementation and impact of the PHS voluntary prenatal screening recommendations in terms of (1) their implementation in official guidelines and statements of medical professional organizations, as well as in state law and regulations; and (2) actual testing rates and provider practices. This chapter concludes that although extensive efforts have been made to implement the recommendations, and there have been major successes, there are still substantial gaps in the number of women who are not tested for HIV, largely because either they receive no prenatal care or their prenatal care providers do not advise them to be tested.

The final chapter begins with the committee's central recommendation—that HIV testing, with patient notification, should be a routine and universal component of prenatal care—and a series of more specific recommendations related to the establishment of this approach in prenatal care. The infrastructure must include, for instance, education of prenatal care providers; the development and implementation of practice guidelines, clinical policy performance measures, and Medicaid managed care contract language for prenatal HIV testing; efforts to improve coordination of care and access to high-quality HIV treatment; interventions



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